J.Jpn. Surg. Soc.. 122(4): 369-374, 2021

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HISTORY OF ANUS-PRESERVING SURGERY

The pull-through anus-preserving surgical procedure was introduced in Japan by Jinnai around 1960. It was performed transabdominally and transanally in two stages . Anterior resection of the rectum, which started around the same period in North America and Europe, was performed transabdominally as one-stage surgery. Anterior resection was started by Kon and Yasutomi et al. in Japan during the 1960s. Those procedures marked the beginning of sphincter-preserving surgery. Anastomosis of the rectum using the single-stapling technique was developed in the 1970s, and anastomosis with the double-stapling technique in the 1980s. These techniques enabled lower and safer anastomosis during low-anterior resection. Anus-preserving surgery, which was developed in the 1990s as a procedure with excision of part of the anal sphincter and anastomosis of the colon and anus, enabled excision of cancerous lesions near the anus. This procedure began to be performed in Japan around 2000 after evaluating its safety in specialized institutes. The procedures of sphincter-preserving surgery are consistent with those performed during laparoscopic and robotic surgery. Transanal local excision, transanal endoscopic microsurgery, minimally invasive transanal surgery, etc. are regarded as the ultimate anus-preserving surgical techniques. Anus preservation through the “watch-and-wait” technique after chemoradiotherapy and the combination of chemoradiotherapy with local excision can be alternative methods for anus preservation.

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